The fight against meth: Price increase coming under proposed law

Thursday

Jan 30, 2014 at 11:58 AM

Editor's note: This is the fourth in a series of articles examining a proposed ordinance to require a prescription for most pseudoephedrine-based drugs in Kirksville. Pseudoephedrine is the key ingredient in the production of methamphetamine.

Editor's note: This is the fourth in a series of articles examining a proposed ordinance to require a prescription for most pseudoephedrine-based drugs in Kirksville. Pseudoephedrine is the key ingredient in the production of methamphetamine._____

Support may be mixed among Kirksville pharmacists and physicians, with many local retailers opting to sit out the debate, but it appears clear that if the Kirksville City Council proceeds with its plan to restrict pseudoephedrine products, getting sick will cost more.

The proposed measure up for consideration at the Council's next meeting Monday will mean consumers will have to jump through more hoops to obtain the same drugs they can get now for displaying an ID and signing a log book.

In the end, the goal for the measure is that criminals, too, will have to jump through those same additional hoops and tire of the process or seek their fix elsewhere.

Both legitimate and illicit buyers of PSE products, like Sudafed or certain Claritin products, will likely pay up to 10 times more for the same remedy they get today over the counter due to increased prescription overhead and doctor's visits.

Of the six pharmacies in Kirksville that currently sell PSE products, none spoke out in support of adding restrictions to PSE products while Rider Drug owner Craig Harris and a statement issued by Walgreens opposed the measure.

At the same time, while Walmart has not taken a stance on the matter nationally, local Walmart Pharmacy Manager Brad Polovich expressed his personal opposition to the restrictions, citing concern for the consumers.

Representatives from Hy-Vee and A.T. Still University's Gutensohn Clinic declined comment citing policy while local Elliott Pharmacy declined to comment citing the fact it employs City Council member Bob Russell.

Fewer boxes sold

Local retailers stand to see their sales of PSE products drop but the impact to the consumers or health care providers is unclear, according to a 2013 report issued by the Government Accountability Office.

The report states that in both Oregon and Mississippi, where the states enacted similar PSE restrictions, overall fewer packages of PSE products were sold with fewer consumers willing to go to the lengths of seeing a doctor and obtaining a prescription.

According to data from Mississippi, in the two years since enacting its restriction law, its reported sales of PSE products plummeted from about 750,000 to 191,000 a year. The estimates are conservative, the report notes, because Walmart does not report its sales numbers.

The numbers show consumers either switched to a different product, went without or purchased their medicine out of the jurisdiction of the restriction laws.

The GAO report highlights that while the impact remains unclear, consumers do pay more for their pseudoephedrine prescriptions, whether it's for the cost of time and travel for a doctor's appointment and any associated co-pays or out-of-pocket charges, in addition to the higher costs for any PSE products that previously were sold as over-the-counter.

"The actual costs to a given consumer for that person's time, travel, and insurance coverage can vary from consumer to consumer depending on the person's individual circumstances," the report states.

For example, the uninsured will likely face higher costs to obtain PSE products than those with health insurance.

But despite the increases in the effective prices of PSE products, consumers in Oregon and Mississippi have been quiet, making few complaints about the laws' impacts.

At the same time, officials are unable to point to a correlating increase in the sale of phenylephrine (PE) products, a similar decongestant that is not used to manufacture methamphetamine.

Prices driven up

At the doctor's office, the proposed ordinance would take a sickness that had previously been addressed with a pharmacy stop and a PSE product to generally require at least a visit with the physician and issuing of a prescription order.

The ordinance will take what used to be at most a $10 sickness and turn it into much more, said Rider Drug's Craig Harris.

"Part of me says, 'Hey, if it decreases [meth] use, that's great. We don't want drugs here.' But another part of me says, 'It takes a $10 over-the-counter thing and turns it into a $75 doctor's visit and $20 prescription,' and that's not right either," Harris said.

The increased costs solely on the drug are attributed to additional overhead to process a drug as a prescription instead of an OTC.

While some physicians will prescribe a patient medications under individual circumstances over the phone or without an examination, it's unlikely that most physicians would cooperate without an ongoing relationship with a patient or other unique circumstances.

"Under some circumstances we might prescribe something for a patient without an exam but under most we'd say, 'Hey, let's take a look at you," said Kirksville physician Dr. Justin Puckett, with Complete Family Medicine, one of the clinics that could expect to see a surge in customers looking for their PSE prescriptions. "It's not about trying to drive business to the practice.

Sometimes the right thing to do is make an assessment before prescribing a product."

Puckett said he will commonly encounter patients that have been using PSE products long-term, in direct conflict with its directions, or have liver, heart or thyroid disease, diabetes or high blood pressure.

"Used long-term, PSE products are a bad idea with the way it causes decongestant," Puckett said. "I'll have patients taking Claritin-D over-the-counter daily for a year and that's a bad idea and that's not a commonly understood bad idea."

'It's drastic'

For many in opposition, the proposed ordinance represents a much larger problem than potential solution to the meth epidemic.

"You're throwing the baby out with the bath-water," Harris said. "You're hurting good people going through seasonal allergies, people who just want to get through the day. I applaud anything that keeps drugs away from our country or our town, but I can't support it. It's drastic."

Brad Polovich, pharmacy manager at Walmart, said personally he doesn't believe the measure would have a positive impact in homes, especially with the relative proximity of other pharmacies in La Plata and Macon, just outside of Adair County.

"When my kids get sick, I'll just drive to La Plata," he said. "Even with gas being expensive, it'll still be less."

Polovich said he didn't believe it is fair to punish legitimate, and suffering, drug users.

"I don't think we can justify banning over-the-counter cold medicine just because people abuse it. I wish someone would speak for the consumers, the law-abiding citizen. They seem to be left out of the equation," he said. "What happens if you get sick on a Thursday, or Friday, especially with a kid, it may be a week until you can see a pediatrician. If you're sick with a common malady, it could still be three or four days to see a doctor."

Walgreens' corporate office also joined in opposition, issuing a statement this week that urges use of existing enforcement practices like database tracking of PSE buyers.

"We believe measures like these increase the costs of health care and make access to needed cough, cold and allergy medicines more difficult in medically under-served areas," the statement reads in response to a request for comment.